The Scribe

July 2014

Nathalie M. Johnson, MD, medical director of Legacy Cancer Institute and of Legacy Breast Health Centers couldn’t believe it when the radiologist called her on the phone. Johnson had undergone her routine screening mammography that day, and seen her results afterward.

“I looked at the 2-D pictures,” she says. “They looked fine.” But the radiologist who called had also reviewed pictures taken on Legacy Health’s new 3-D mammography equipment, and told Johnson, “It looks like there’s something.”

There was. About a year ago, Johnson was diagnosed with HER2-positive breast cancer, one of the more aggressive types of breast cancer.

It meant she would have to undergo chemotherapy. Because Johnson— a breast cancer specialist - had the advantage of knowing the ins and outs of her particular case, as well as the advantages and disadvantages of various therapy approaches.

She chose to have chemotherapy before surgery, in order to see how the tumor responded. She also took Herceptin for a year, and will remain on tamoxifen for seven years. She decided to have bilateral mastectomies. Her medical training had prepared her for making decisions about treatment, but she had to figure out the rest on her own, such as whether to talk about her disease publicly, and whether to share it with patients.

“Initially, I wanted to be private about it,” she acknowledges. Her mother had had breast cancer, and she survived it, so Johnson looked to her example and decided to share her own experience with cancer.

Johnson says going through treatment herself allowed her to see things from the patients’ perspective in a different way. She felt she always had been supportive and empathetic, but now she realizes even more what patients are going through, including “the hopes and expectations.”

For example, sometimes during treatment, physicians will advise patients that they would benefit from additional therapy. Patients commonly react despondently to that news. Having been a patient now herself, she sees that “when you change the schedule, it’s like moving the finish line,” she says. “I have a deeper appreciation.”

In addition, although she had always recommended that patients seek complementary therapies such as acupuncture, massage therapy and herbal treatments, after her own diagnosis when she tried them herself, she became more aware of how they helped, she says. “Now I stress their importance and the value they add.”

During chemotherapy treatment, she cut back her schedule to half time. At the beginning of June, when she had her final chemo treatment, she was slowly coming back to full time.

“A gift that cancer has given me is to re-evaluate life balance,” Johnson says. Prior to her cancer, “I had a ridiculous schedule,” she admits. “I see now I have grown and become a better wife, a better person, a better doctor. I wouldn’t want to go through it again, but I’ve gotten many gifts from it.” She said that after years of supporting others, she has in turn been supported by everyone she encounters who knows about her disease.

“One of the things that’s been professionally a challenge” is whether and when to share her own experience with her patients. She doesn’t do that routinely, partly because she believes each individual should decide with her doctor the treatment regimen to pursue. But Johnson does share her story if a patient knows and asks about it, or if “I think it will allay a fear or be helpful to them.”

Johnson is a person of faith, and she has prayed a lot during her disease and treatment. Her first response to being told she had breast cancer was: “Why me? Why couldn’t I get a breast cancer that doesn’t require chemotherapy? Why? Then it came to me, ‘Why not? Why would I be special? So many people have had that and had to go through it.’“

She acknowledges the irony of coming down with something she specializes in helping others try to overcome, “but I feel in so many ways it has been good,” she says. “As physicians, we struggle with illness (in ourselves) as being seen as weakness.
Like, ‘Don’t let them see you sweat,’ that you’re vulnerable, and feel your colleagues look at it that way. It’s kind of silly. All of us are human.” Instead, Johnson says, doctors should think and talk about how to take care of themselves at a time when they are ill, and how they can make sure their patients are taken care of in the meantime.

Johnson is thankful that Legacy had installed 3-D mammography, which it now has at all four of its hospitals even though insurers don’t pay any extra for using that more-expensive technology, despite its superiority in providing comprehensive images and greater clarity compared with the standard 2-D mammography.

“Legacy had a commitment to go ahead and do it and not charge the patient for the difference,” she says. The 3-D played an essential role in her finding her own cancer, she says. Her diagnosis would have been made “eventually,” she says, but with the aggressive form of breast cancer she had, it probably would have spread before detection.